Project:
Project Location:
Title of Job Filled:
Skills Required:
Applicant Name / Section 3
Eligible
Person / Address / Date Interviewed
Yes / No
Note: The Developer/Owner/Contractor/Subcontractor shall conduct interviews that result in equal and fair competition among all applicants. All efforts and processes conducted shall be fully documented, including verifiable reasons for the selection of each new employee. Section 3 residents that test qualified must be given preference to be hired for those positions.
It will be the responsibility of the Section 3 resident to demonstrate their qualifications and show their ability to compete for the open job classification. 24 CFR 135 does not require the employment of a Section 3 resident who does not meet the qualifications of the position to be filled (24 CFR 135.34(c)).
Of the applicants interviewed for this position, the following person was hired:
______
effective ______(date)
Yes No Section 3 Resident
Yes No Household income of $______meets the income eligibility guidelines for a low- or very-low income person as defined in the current HOME Program Income Limits as published by HUD.
Theapplicanthiredwasthebestcandidateforthisopeningbecause______
I affirm that the above statements are true, complete, and correct to the best of my knowledge and belief.
By: ______Date: ______
Name: ______Title: ______
Interview Log & New Hire Summary
SECTION 3 ELIGIBLE PERSONS CERTIFICATION
Section 3 residents residing in the service area or neighborhood in which the Section 3 covered project is located may seek priority consideration for new employment, training, and contracting opportunities resulting from HUD-funded projects. A person seeking preference in training and employment as provided by CFR 135.34 shall submit evidence and certify to the Recipient/Contractor that he/she qualifies for Section 3 status as defined in Section 135.
PROJECTNAME:______
PROJECT ADDRESS: ______
ApplicantName: ______
Applicant’s Permanentaddress:
______
______Phone No. ______
Yes No LegalresidentoftheHousingAuthorityof______
Yes No Holder of Section 8 voucher from the Housing Authority of______
Yes No Reside in the municipality/county of ______
Yes No Participant in HUD Youthbuild program? If yes, indicate the Youthbuild Program:
______
Family size (Number in Household): ______Household Income: ______
Yes No Household income meets the income eligibility guidelines for a low- or very-low-income person as set forth in the current HOME Program Income Limits as published by HUD (see attached).
I have attached the following documentation as evidence of my status:
Picture identification card must be presented to validate identification.
Attach copy of lease Other evidence (specify):______
Attach copy of evidence of participation ______
in a public-assistance program.
It will be the responsibility of the Section 3 resident to demonstrate their qualifications and show their ability to compete for the open job classification. Nothing in this part shall be construed to require the employment of a Section 3 resident who does not meet the qualifications of the position to be filled (24 CFR 135.34(c)). Please complete skills inventory on page 2.
I, ______(print individual full name), certify that my answers in this Section 3 Eligible Persons Preference Certification are true and accurate to the best of my knowledge. I also understand that false or misleading information in this Section 3 Eligible Persons Preference Certification or any subsequent interviews may result in penalties including, but not limited to, decertification from the Section 3 program and/or termination from employment.
Signature ______Date: ______
SECTION 3 RESIDENT CONFIRMATION:
I, ______(Print Name and Title) of ______certify that the person signing above is a Section 3 Eligible Person as defined in CFR 135.5.
Signature:______Date: ______
Section 3 Eligible Persons Certification Page 1 of 2
SECTION 3 ELIGIBLE PERSONS CERTIFICATION (Continued)
SKILLS INVENTORY
PROJECTNAME:______
PROJECT ADDRESS: ______
ApplicantName: ______
Please check the job categories that correspond to your capabilities/experience:
Yes No Asbestos Worker Yes No Laborer
Yes No Bricklayer Yes No Landscaping
Yes No Carpenter Yes No Machinist
Yes No Carpet/Flooring Yes No Office/Clerical
Yes No Cement Mason Yes No Other (specify:______)
Yes No Clean-Up/Clean-Out Yes No Other (specify:______)
Yes No Demolition/Excavation Yes No Painter
Yes No Drywall Yes No Plaster
Yes No Electrician Yes No Plumber
Yes No Elevator Constructor Yes No Roofer
Yes No Finishing Yes No Safety-Security
Yes No Glazier Yes No Sheet Metal
Yes No HVAC Yes No Tile Setter
Yes No Insulation Yes No Training
Yes No Iron Worker Yes No Vinyl Siding
Yes No Janitorial Yes No Window/Door Installation
Experience: For each job category checked above, please briefly summarize your level of skill:
______
______
______
______
Supervision experience: Can you supervise a crew in any of the job categories you checked above?
Yes No If yes, please explain what supervision experience you have:
______
______
Please indicate what and how many tools you can bring for yourself and your crewmembers:
______
______
______
Please list any scheduling issues: ______
Please list any health, physical or other special conditions that should be considered when assigning you to a particular job: ______
Section 3 Eligible Persons Certification Page 2 of 2
SECTION 3 BUSINESS CONCERNS CERTIFICATION
Name of Business
______
Address of Business
______
Type of Business: Corporation Partnership
Sole Proprietorship Joint Venture
Attached is the following documentation as evidence of status:
For business claiming status as 51% or more owned by Section 3 residents:
List of all owners with a copy of one of the following for the Section 3 residents:
Copy of resident lease Otherevidence______
Copy of evidence of participation in a ______
public assistance program
For business entity as applicable:
Copy of Articles of Incorporation Certificate of Good Standing
Assumed Business Name Certificate Partnership Agreement
List of owners/stockholders Corporation Annual Report
and % ownership of each Latest Board minutes appointing officers
Organization chart with names and titles Additional documentation ______
and brief function statement ______
For business claiming Section 3 status by subcontracting 25 percent of the dollar awarded to qualified Section 3 business:
List qualified Section 3 business(es) and subcontract amount(s) with copies of executed contracts attached.
For business claiming Section 3 status as at least 30 percent of their workforce are currently Section 3 residents or were Section 3 eligible residents within 3 years of date of first employment with the business:
List of all current full-time employees showing date of hire together with a copy of the following for those employees claiming Section 3 status:
PHA/IHA Residential lease less than Other evidence of Section 3 status less than
3 years from date of employment 3 years from date of employment
Evidence of ability to perform successfully under the terms and conditions of the proposed contract:
Current financial statement Statement of ability to comply with public policy
List of owned equipment List of all contracts for the past two years
Other:______
Name of Business: ______
By:______
Signature Date
Print Name & Title:______
Section 3 Business Concerns Certification